Determining PBM Performance Just Got Easier

Relying on your PBM to tell you how well they are performing, isn’t enough to verify that contractual guarantees are being met. They may be living up to contractual agreements, but unless you’re reviewing each and every prescription claim, you can’t be sure.

PillarRx’s PBM audit methodology compares contract terms and service guarantees to actual PBM performance. We provide clients reliable, non-biased results that determine if money is owed back or if your PBM is performing up to contractual obligations. As an independent, third-party auditor, our team of professionals have extensive experience reviewing PBM contracts and leading a thorough review of pharmacy benefit programs.

PillarRx conducts over 350 audits per year utilizing 100% review of your pharmacy claims through our proprietary tools.

PillarRx is an approved vendor of all PBMs. Throughout our company’s history, our factual, non-biased approach has allowed us to work with over 35 PBMs. Our nearly 50 years of combined experience, has helped countless customers maximize their financial outcomes, eliminate pharmaceutical waste and abuse, and increase member satisfaction. We do this by providing the best-in-class, value-based pharmacy solutions utilizing 100% review of your pharmacy claims.

HERE ARE SOME OF THE AUDIT SERVICES WE PROVIDE:

  • Data Validation (Medicare Part C+ D)
  • Pricing
  • Rebates (Manufacturer, Reconciliation, Point-of-Sale)
  • J-Code Specialty Analysis
  • Plan Design
  • Pre/Post Implementation
  • Operational Review
  • PDE Analysis
  • EGWP/RDS

What People Are Saying

Our team relies on PillarRx to make us better! While we had seen significant issues with managing our pharmacy benefit program, PillarRx provided a program assessment. The assessment helped find coverage gaps and areas of improvement. Since we’ve started working with PillarRx we have seen no issues, no disruption, and exceptional service and partnership for over 7 years. 

Following the PillarRx audit, we learned that our PBM contract should be renegotiated in terms of allowing the administrator to keep all the pharmacy rebates. We learned that this contract arrangement is behind the market, outdated, and non-competitive, and needs to be more transparent. We recommend other municipalities go through a competitive RFP process for proposals that offer competitive pricing, utilize technology, and offer additional follow-up consultation services.

We knew rebate sharing opportunities were available for our plan. We hadn’t updated our PBM contract and needed help. PillarRx adjusted contractual terms and we saw immediate cost-savings. We look forward to PillarRx’s results following additional financial performance audits. 

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